Three-dimensional left atrial strain is associated with heart failure and cardiovascular death in the general population

BACKGROUND: Left atrial (LA) reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct) by three-dimensional (3D) echocardiography (3DE) are measures for characterizing LA function. The association between LA strain by 3DE and incident heart failure (HF) and cardiovascular (CV) death has not previously been investigated in the general population.

METHODS: The 5th Copenhagen City Heart Study was a prospective longitudinal cohort study that examined a sample of the general population using comprehensive transthoracic echocardiography, including 3DE, where LASr, LAScd and LASct were quantified. The endpoint was a composite of HF and CV death. Cox proportional hazards regression was applied. Models were adjusted for the ARIC-HF risk score (age, sex, heart rate, systolic blood pressure, antihypertensive medication, diabetes, ischemic heart disease, smoking, and body mass index).

RESULTS: Among the 1954 included participants, mean age was 54 ± 17 years and 43% were male. During a median follow-up time of 4.8 years (interquartile range 4.3-5.4 years), 89 participants (4.6%) experienced the composite endpoint of HF or CV death. After a multivariable adjustment, LASr remained significantly associated with the outcome (HR 1.28 (95% CI 1.08-1.52); p = 0.004, per 5% decrease) while LAScd (HR 1.23 (95% CI 1.23 (95% CI 0.99-1.55); p = 0.064; per 5% decrease) and LASct (HR 1.23 (95% CI 0.98-1.54); p = 0.08, per 5% decrease) did not.

CONCLUSION: LASr assessed by 3DE is independently associated with incident HF and CV death.